| NPI | 1902174881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 007480) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038012087) |
| Enumeration Date | 2011-12-07 |
| Last Update Date | 2022-05-23 |